Gynecology

Dr. Helen Albao

Types of patients:
1. Neonates
-Vaginal discharges or bleeding
-commonly due to physiologic
withdrawal of maternal estrogen;
- the anxious & justifiably
apprehensive mother needs
reassurance

2. Young child
-Pruritus or discharge
-MDs responsibility
-to avoid creating fear or apprehension
- Gentleness is mandatory
- examination should never be compromised
bec. Of the childs possible sensitivity.
Sarcoma botryoides
- on rare occasion this is a significant pathology
Overnight hospitalization & pelvic evaluation under
anesthesia may be required.
- less traumatic than examining a frightened
child in the office.

3. Adolescent
- Common complaints- be discussed
openly & treated appropriately
-Breast development
- Vaginal discharge
- irregularity of menses and
-painful menstruation
Reassurance is important, regardless
of the findings

Medical history
-General data
Name, Age, G/P, LMP, PNMP, AOG, ESG,
Date & time of Admission, Name of hospital/
clinic
-Chief complaint
-HPI
-Menstrual history
Obstetrical history
Past medical/ surgical history
Family History
Nutritional History

G/P Gravidity/ Parity

G- refers to the gravidity/ state of
pregnancy
P-refers to parity expressed in 4
digits (FPAL)
1st digit- Full tem pregnancy (37 wks
gestation and beyond)
2nd Preterm preg. (21-36 weeks
gestation)
3rd- Abortion (20 weeks gestation &
below)

G1P0- presently pregnant for the 1st

time
G1P001- had 1 full term preg. 1 living
child
LMP- 1st day of the last normal
menstrual period
EDC- expected date of confinement
EDD- espected date of delivery/
Naegeles rule
AOG- total no. of completed weeks of
pregnancy from LMP

Chief Complaint
-Primary reason for Patients admission, singular
-Common gynecological complaints
-Vaginal discharges
-bleeding, Purulent discharges, foul
smelling discharges
-Pruritus vulva
-Pelvico-abdominal mass
-Dysuria
-Dysmenorrhea
-Dyspareunia
-Profusion of mass in the vaginal outlet
-Infertility

History of Present illness

HPI Detailed, narrative story of the reason
for admission in chronological order until the
time the patient decided to seek admission.
Ex. The present condition started as vaginal
bleeding which was noted 2 days PTA.
-associated symptoms
-Precipitating & Aggravating factors
-Consultations/ Medications/ drugs
taken/relief etc.

Menstrual History

Menarche
Days Cycle
Number of days
Amount of Flow
Associated symptoms
- Dysmenorrhea, painful defecation, dysuria,
pruritus
Ex. 13x 28x 3-5, moderate flow, used 2-3 pads,
pruritus associated with dysmenorrhea or
premenstrual pains.

Obstetrical history
No.

year Out
com
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pre
g.

Plac Birt
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deli wgt
very
;
han
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by
MD,
mw,
hilo
t

Con Feta Mat

diti l
ern
on
sex al
at
com
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atio
APG
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AR
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e

Medical Records

Past medical/ surgical history

Family history
Nutritional history
Physical Examination
Admitting Dx
Differential Dx
Diagnostic work-up
Final Dx.

Physical Examination
Objective findings
-Examined conscious, coherent, cooperative,
ambulatorywith the ff. vital signs
-BP, Temp, PR, RR
- HEENT
-Neck
-Chest & Lungs
-Heart
-Breast
- Abdomen
-Genitalia

Physical exam
Breast/ Chest & Lungs/ abdomen
-inspection, Palpation, percussion,
Auscultation
Genitalia
-Inspection
-bimanual pelvic Exam (Digital exam)

Genitalia

Inspection
Vulva (External)
Gross Appearance
Discharges
Speculum exam
- Vagina, cervix
Bimanual Pelvic exam

Speculum exam
Empty the Urinary bladder
Lithotomy position
-the px. Lying supine on the examining
table with her legs in stirrups
-Examining Gloves and Vaginal
speculum

Speculum: 3 sizes
Small
-Young children, virgins, tight perineal
repair, menopause
Meduim used for most women
Large- useful in large or obese
women or those who are grand
multiparas

Speculum exam
Transverse diameter of the blades inserted in the
A-P position & Guiding the blades through the
introitus in a downward motion with the tips
pointing towards the rectum.
-Because the Anterior wall of the Vagina is
backed by the public symphysis, which is rigid,
pressure upward causes the patient discomfort.
-the resting state of the Vagina lies on the
rectum and actually extends posteriorly from the
introitus.
May be facilitated by placing 2 fingers into the
introitus & pressing down.

 Speculum exam
- Once the blades are inserted the
speculum should be turned so that
the transverse axis of the blades is in
the transverse axis of the vagina.
-The blades should be inserted to their
full length,
-Open to inspect the vaginal walls &
cervix.

Inspection of the Cervix

Pink, shiny, and clear
Nulliparous individual, the external
os should be round
Parous, the external os takes on a
fish-mouth appearance
Stellate Healed cervical lacerations

Speculum exam
Normally, the transofmation zone
(i.e., the junction of squamous and
columnar epithelium) is just barely
visible inside the external os.

Bimanual Pelvic exam

Index & middle fingers of the dominant
hand are placed within the vagina, and the
thumb is folded under
-so as not to cause the patient distress in
the area of the mons pubis, clittoris, and
pubic symphysis.
-The fingers are inserted deeply into the
vagina so that they rest beneath the cervix
in the posterior fornix.

 The 2 fingers of the vaginal hand are

then moved into the right vaginal
fornix as deeply as they can be
inserted.
The abdominal hand is placed just
medial to the anterio superior iliac
spine on the right.
The 2 hands are brought as close
together as possible.
With a sliding motion from the area
of the anterior superior iliac spine to
the introitus, the fingers are swept

Rectovaginal Exam
The middle finger is relubricated w/ a
water soluble lubricant and placed
into the rectum.
The index finger is reinserted into the
vagina
Palpate the 1. Rectovaginal septum
2. Uteroscaral ligaments - Any
thickening or beadiness of these
structures may imply an
inflammatory rxn or endometriosis.

Preventive Medicine in Womens

health